Figure 525

Glomus tumour.

Treatment is by surgical excision. Small tumours may be removed by punching a 6 mm hole in the nail plate, incising the nail bed and enucleating the lesion. The small nail disc is put back in its original position as a physiological dressing. Larger tumours may be treated after removal of the proximal half of the nail plate; those in lateral positions are removed by an L-shaped incision parallel to and 4-6 mm on the volar side of the lateral nail fold. The nail bed is carefully dissected from the bone until the tumour is reached and removed. This is usually curative, although the pain may take several weeks to disappear. Recurrences occur in 10-20% of cases and may represent incomplete excision or adjacent tumours overlooked at the initial operation, or genuine new growth. More extensive surgery than is usual might achieve more first-time cures.

Subungual exostoses are not true tumours but rather outgrowths of normal bone or calcified cartilaginous remains (Figure 5.26). Whether or not subungual osteochondroma is a different entity is not clear. Subungual exostoses are painful bony growths which elevate the nail. They are particularly frequent in young people and are mostly located in the great toe, although less commonly subungual exostoses also occur on the fingers. They start as small elevations of the dorsal aspect of the distal phalanx and eventually emerge from under the nail edge or destroy the nail plate. If the nail is shed, the surface becomes eroded and secondarily infected, sometimes mimicking ingrown toe nail. Walking may be painful.

Subungual exostosis

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